Spinal cord infarction

OVERVIEW

Spinal cord infarction is necrosis of a portion of the spinal cord as a result of an interruption of the blood supply to the spine

RISK FACTORS

  • female sex
  • atrial fibrillation with no anticoagulation
  • hypertension
  • hypercholesterolemia
  • type II diabetes
  • smoking
  • hypercoagulable states

ASSESSMENT

History

  • Acute tetraparesis or paraparesis with a sensory level corresponding with level of cord infarct
  • No historical suspicion of trauma or infection
  • 60 % of patients present with pain that localizes to the level of injury
  • May be associated with aortic surgery or procedures such as celiac ganglion ablation
  • Risk factors may be present

Examination

  • Anterior spinal artery syndrome is most common: loss of motor function and pain/temperature sensation, with relative sparing of proprioception and vibratory sense below the level of lesion
  • Initially presents with a flaccid paralysis and loss of deep tendon reflexes
  • Usually bilateral weakness, occasionally unilateral
  • Posterior spinal artery syndrome: loss of proprioception and vibratory sense below the level of the injury and total anesthesia at the level of injury; weakness usually mild/transient
  • Other variants possible

Investigations

  • MRI is diagnostic, showing an ischemic lesion defined as a well-demarcated T2-weighted hyperintensity matching an arterial territory of the cord
  • Spinal angiogram recommended if vascular malformation suggested from MRI

MANAGEMENT

  • Resuscitation to address immediate life threats
  • Supportive care and monitoring
  • Corticosteroids are not currently recommended
  • Anti-platelet agents may be used if coexistent vascular risk factors/ comorbidities are present,to reduce the risk of further atherothrombotic/ embolic events

CCC Neurocritical Care Series

Journal articles

  • Flower O, Bowles C, Wijdicks E, Weingart SD, Smith WS. Emergency neurological life support: acute non-traumatic weakness. Neurocrit Care. 2012 Sep;17 Suppl 1:S79-95. PMID: 22972018.
  • Novy J, Carruzzo A, Maeder P, Bogousslavsky J. Spinal cord ischemia: clinical and imaging patterns, pathogenesis, and outcomes in 27 patients. Archives of neurology. 63(8):1113-20. 2006 [PMID 16908737]

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the  Clinician Educator Incubator programme, and a CICM First Part Examiner.

He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.

His one great achievement is being the father of three amazing children.

On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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